A systematic review of studies concerning observer agreement during medical specialist diagnosis using...

We conducted a systematic review of studies of observer agreement for medical specialist diagnosis via videoconferencing. The review was based on searches of electronic databases and a hand search of relevant journals and reference lists between 1966 and June 2010. There were 20 studies comparing videoconferencing diagnosis with a non-telemedicine alternative by reporting a measure of agreement. Half of the studies were in the field of dermatology; these studies provided solid support for the reliability of videoconferencing. The other 10 studies were in psychiatry, geriatrics, minor injuries, neurology and rheumatology. Reliability of diagnosis via videoconferencing was confirmed in all studies. In the studies where physical examination was an element of the diagnostic process, results were reliable but authors recommended greater care during the diagnostic process (e.g. good equipment, onsite support, additional camera angles). Four studies incorporated a second group to measure agreement in paired face-to-face assessments. Although useful evidence for the reliability of diagnosis via videoconferencing was provided by the studies in the review, the range of medical specialties was small. The variation in research methodology and statistical analysis suggests a lack of clarity about which research design is appropriate for measuring observer agreement in relation to diagnostic reliability.